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HHRC-EOC 02.10.2017 2 Evidence of Coverage <br />I. DEFINITIONS <br />The following terms have the following meanings for purposes of this Combined Evidence of <br />Coverage and Disclosure Form. <br />A. "Act" means the Knox-Keene Health Care Service Plan Act of 1975, as amended <br />(California Health and Safety Code, Sections 1340 et seq.). <br />B. "Benefits" means the services to which Members are entitled under an EAP Services <br />Agreement, and which are described in Exhibit A to this Combined Evidence of Coverage <br />and Disclosure Form. <br />C. "EAP Provider" means the licensed assessment and short-term counseling mental health <br />professionals employed by, or under contract with, Plan to provide Benefits to Members. <br />D. "EAP Services Agreement" means the Employee Assistance Program (EAP) Services <br />Agreement between Plan and Group, which establishes the terms and conditions governing <br />the provision of Benefits to Members by Plan. <br />E. “Exclusion” means any provision of an EAP Services Agreement whereby coverage for <br />Benefits is entirely eliminated, and which is set forth in Exhibit A to this Combined <br />Evidence of Coverage and Disclosure Form. <br />F. "Plan" means Health and Human Resource Center, Inc., doing business as Aetna Resources <br />For Living. <br />G. "Group" means the company that has entered into an EAP Services Agreement with Plan <br />for Plan to provide Benefits to Members. <br />H. "Limitation" means any provision of an EAP Services Agreement, other than an Exclusion, <br />which restricts Benefits, and which is set forth in Exhibit A to this Combined Evidence of <br />Coverage and Disclosure Form. <br />I. “Enrollee” means any eligible employee of Group who (1) resides in California and (2) <br />may be covered under the Act. <br />J. "Member" means an Enrollee covered by Group, as defined above, the Enrollee’s children <br />under the age of 26, persons covered under the Enrollee’s health benefit plan, and persons <br />residing with the Enrollee, including domestic partners of the same or opposite sex. <br />K. “Emergency Services” means medically necessary transport using the 911 system or <br />medical screening, examination and evaluation by a physician to determine if an <br />emergency medical condition or psychiatric emergency medical condition exists. <br />REV: 03-10-23 MI <br />ATTY/AGR.2023.039/Aetna (EAP Services Agreement) (Page 26 of 42)